Mom's symptoms might be manifestation of trauma

Published 3:07 pm, Friday, February 14, 2014

Q: I am truly beside myself. I just don't know who else to turn to. I must have talked to dozens of different doctors, and no one is able to help me. This is about my mom. She is only 59. She had me and my twin brother early.

About six months ago, my mom started losing the ability to speak. Initially, we thought she had a cold, except the cold never went away. She has seen an ear, nose and throat specialist and a neurologist. She must have had 10 different X-rays and an MRI. They also worried she may have seizures. Then they worried she had ALS, also known as Lou Gehrig's disease. But the tests show nothing.

In the meantime, she continues to function at home. She and my dad are divorced, so she lives alone. As you can imagine, I worry about her every day. The doctors tried seizure medications and they didn't work. The speech therapy didn't help either. She gets better for a while and then she gets worse again. She is obviously worried, as well.

What do you think is going on? How can we help her?

Kim

A: I feel your pain and frustration. I need to be humble, as many very smart doctors have tried to help and failed. However, there is one possible diagnosis. I am talking about conversion reaction.

It happens after an event, but may not happen immediately. Some believe there may be as long as 15 to 20 years between the event and the onset of symptoms.

This is what the old term "hysteria" actually meant. It came to fame at the end of 19th century, and was popularized by three doctors -- neurologist Jean-Martin Charcot and two psychiatrists, Sigmund Freud and his colleague, Pierre Janet. Their main contribution was to give validity to conversion reaction as a true medical disorder.

Before that, people with unexplained symptoms were thought to be "faking it" and their problems were considered be all in their head.

This disease is still present today, although it is difficult to truly know how common it is. It appears to present more frequently in non-North American cultures.

Women are affected much more often than men, and it is a disease of mostly younger patients. The likelihood of this malady peaks around the late 30s, but it can be present at any age. It's also more common among family members of patients with this condition. Financial stress is also listed as a risk factor.

The symptoms of conversion disorder fall into two categories. One is connected to movement, with the illness presenting as numbness, paralysis, loss of speech, fainting, difficulty walking, and difficulty urinating and swallowing.

The other set of symptoms is connected to impaired senses. This includes vision and hearing loss, as well as distorted touch or the sensation of pain. Symptoms appear suddenly and are often, but not always, short lived, lasting a few weeks or months. Recurrence is common. About 25 percent of conversion reaction patients who get better have another episode within the next year.

How does one diagnose conversion disorder? There are three criteria, and all have to be met, although that is easier said than done.

First, there has to be no explanation found in the form of tests, blood work, X-rays and such. The second criteria is eliminating patients who essentially pretend or "fake it," usually to gain something. Some patients get caught, or simply confess, but if they don't, we may actually never know for certain.

The last requirement is the easiest to establish. There needs to be a history of an emotional event or trauma.

Very often, this will be a history of sexual and physical abuse. This could have happened many, many years before symptoms start. More often, though, the connection is closer in time.

Most of the time, diagnosing conversion reaction requires the collaboration of many specialists, including neurologists, psychiatrists and primary doctors. I have to also warn you that many doctors are quite biased against this disease.

Many of us physicians still are too arrogant to understand that, just because we cannot find an explanation for a problem, that does not mean that it does not exist.

This is why I believe conversion reaction is quite under-diagnosed. Instead, people will go through endless repetitive tests and X-rays.

For most people suffering from the illness, symptoms go away quickly and do not come back, so there is actually no need for treatment. For more severe situations, a few things have been shown to help.

First, the patient, the doctor and the family all have to agree what they are dealing with.

The very concept of psychological trauma manifesting in physical symptoms is difficult to accept for some of us. Once that hurdle is jumped over, different modalities can be explored.

Psychotherapy and medications to help anxiety and depression can both, especially if used together, make a dramatic difference. This needs to be done under the care of a trusted and open-minded physician, but starting with an honest discussion with the primary doctor is the way to go.

To treat physical symptoms, physical therapy and massage may be an option. Some patients have had success with hypnosis. Many other novel therapies are under investigation, but the results are inconclusive as of now.

My suggestion is to talk about conversion reaction with your mom's doctors first, then with her, as well.

There may be a treatment available that may help her. But it may require for everyone to think outside the box.